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HIAWATHA HOSPITAL ASSOCIATION INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
HIAWATHA HOSPITAL ASSOCIATION INC (EIN 48-0577658)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-11-16
IRS object ID
201513209349304046
Schema version
2014v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-11-16T10:03:22-06:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11201 Walnut Suite 1700AddressLine1Txt
CityKansas CityCityNm
State AbbreviationMOStateAbbreviationCd
ZIP641062246ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN480577658EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HIAWATHA HOSPITAL ASSOCIATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% JENNY KNUDSONInCareOfNm
Business Name ControlHIAWBusinessNameControlTxt
Phone7857422131PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 UTAH STREETAddressLine1Txt
CityHIAWATHACityNm
State AbbreviationKSStateAbbreviationCd
ZIP66434ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJOHN MOOREPersonNm
Person TitleCEOPersonTitleTxt
Phone7857422131PhoneNum
Signature2015-11-16SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKevin Ensminger CPAPreparerPersonNm
PTINP01310558PTIN
Phone8162216300PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1HIAWATHA COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerJOHN MOOREPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 UTAH STREETAddressLine1Txt
CityHIAWATHACityNm
State AbbreviationKSStateAbbreviationCd
ZIP66434ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$24,408,257GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.HCH-KS.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1945FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionAS A RURAL COMMUNITY HOSPITAL, HIAWATHA HOSPITAL'S PRIMARY GOAL IS TO PROVIDE MODERN, RELIABLE, AND AFFORDABLE HEALTH SERVICES THAT BEST MEET THE NEEDS OF OUR COMMUNITY RESIDENTS.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee299TotalEmployeeCnt
Total Volunteers8TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$105,241PYContributionsGrantsAmt
CY Contributions Grants$354,300CYContributionsGrantsAmt
PY Program Service Revenue$26,132,212PYProgramServiceRevenueAmt
CY Program Service Revenue$23,893,926CYProgramServiceRevenueAmt
PY Investment Income$16,735PYInvestmentIncomeAmt
CY Investment Income$16,147CYInvestmentIncomeAmt
PY Other Revenue$111,655PYOtherRevenueAmt
CY Other Revenue$121,925CYOtherRevenueAmt
PY Total Revenue$26,365,843PYTotalRevenueAmt
CY Total Revenue$24,386,298CYTotalRevenueAmt
PY Grants And Similar Paid$17,861PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$15,854CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$13,907,775PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$13,837,833CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$3,650CYTotalFundraisingExpenseAmt
PY Other Expenses$11,607,099PYOtherExpensesAmt
CY Other Expenses$11,958,117CYOtherExpensesAmt
PY Total Expenses$25,532,735PYTotalExpensesAmt
CY Total Expenses$25,811,804CYTotalExpensesAmt
PY Revenues Less Expenses$833,108PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,425,506CYRevenuesLessExpensesAmt
Total Assets BOY$26,745,965TotalAssetsBOYAmt
Total Assets EOY$22,104,767TotalAssetsEOYAmt
Total Liabilities BOY$11,791,941TotalLiabilitiesBOYAmt
Total Liabilities EOY$8,831,757TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$14,954,024NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$13,273,010NetAssetsOrFundBalancesEOYAmt
MissionTHE BOARD APPROVED MISSION STATEMENT PROMOTES A REGIONAL MODERN HEALTHCARE FACILITY THAT IS BASED ON SOUND FINANCIAL AND STRATEGIC PLANNING WHICH IS GUIDED BY A COMMITMENT TO THE WELL BEING OF ITS COMMUNITY AND EMPLOYEES.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$21,834,846ExpenseAmt
Grant$15,854GrantAmt
Revenue$23,874,140RevenueAmt
DescHIAWATHA COMMUNITY HOSPITAL'S PRIMARY GOAL IS TO PROVIDE QUALITY, MODERN, AFFORDABLE HEALTHCARE TO OUR COMMUNITY. IN 2014, WE PROVIDED SERVICE FOR 3,619 INPATIENT DAYS. WE PREFORMED 138 INPATIENT SURGERIES AND 1,150 OUTPATIENT SURGERIES. WE DELIVERED 84 BABIES. WE PROVIDED OUTPATIENT SERVICES TO 27,328 PATIENTS. BY PROVIDING SERVICES LIKE OBSTETRICS AND 24 HOUR EMERGENCY SERVICES THAT NOT ALL SMALL RURAL HOSPITALS PROVIDE, EVEN THOUGH THE PROGRAMS ARE NOT ALWAYS PROFITABLE FOR THE HOSPITAL, WE FEEL STRONGLY THAT THESE SERVICES PROVIDE NECESSARY CARE TO ADDRESS OUR COMMUNITY'S OVERALL HEALTH WHILE PROMOTING OUR MISSION AS A CHARITABLE ORGANIZATION.Desc
Total Program Service Expenses$21,834,846TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document25IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee299EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldKSStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJENNY KNUDSONPersonNm
Phone7857426210PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 UTAH STREETAddressLine1Txt
CityHIAWATHACityNm
State AbbreviationKSStateAbbreviationCd
ZIP66434ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
DR STEFFEN SHAMBURG
PHYSICIAN/CHIEF OF STAFF40.00.0Yes (X)$413,811$0$33,418
HILLARY BOYE
TRUSTEE0.250.0Yes (X)$0$0$0
LORI ELLIOT
TRUSTEE0.250.0Yes (X)$0$0$0
FONDA LAFRENZ
APRN SECRETARY/BOARD TREASURER3.00.0Yes (X)$5,053$0$0Yes (X)
CHERYL RASMUSSEN
TRUSTEE0.250.0Yes (X)$0$0$0
ERIK MADSEN
TRUSTEE0.250.0Yes (X)$0$0$0
ERIC MCPEAK
BOARD PRESIDENT/TRUSTEE0.50.0Yes (X)$0$0$0Yes (X)
GALEN MEYER
TRUSTEE0.250.0Yes (X)$0$0$0
NICK HRENCHER
VICE PRESIDENT/TRUSTEE0.30.0Yes (X)$0$0$0Yes (X)
ANDY DELANEY
TRUSTEE0.250.0Yes (X)$0$0$0
JOHN MOORE
CEO40.00.0$156,341$0$27,987Yes (X)
DUSTIN WILLIAMS
PHYSICIAN ASSISTANT40.00.0$154,596$0$9,387Yes (X)
DR BRYON BIGHAM
PHYSICIAN40.00.0$268,896$0$33,480Yes (X)
DR PETER ROSA
PHYSICIAN40.00.0$267,772$0$31,888Yes (X)
DR CROSBY GERNON
RADIOLOGIST40.00.0$457,072$0$36,004Yes (X)
DR JULIE ROSA
PHYSICIAN22.00.0$129,773$0$261Yes (X)
JEAN ABEITA
PHARMACIST40.00.0$128,320$0$25,337Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,981,634TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$197,762TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K8IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

ServicesServicesDescCompensationCompensationAmt
STEVEN H GUNNELS
CRNA$598,320
STARS
THERAPY SERVICES$552,304
ROCK PORT TELEPHONE COMPANY
IT CONTRACT SERVICES$266,821
SHARED MEDICAL SERVICES
MRI$211,900
ICE TECHNOLOGIES
EMR SUPPORT HOSTING$210,638
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K8CntrctRcvdGreaterThan100KCnt
Related Organizations$69,155RelatedOrganizationsAmt
Government Grants$4,099GovernmentGrantsAmt
All Other Contributions$281,046AllOtherContributionsAmt
Total Contributions$354,300TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE621110$21,989,421$21,989,421
OTHER PATIENT REVENUE621110$59,334$59,334
340B PHARMACY446110$1,519,909$1,519,909
EMR INCENTIVE REVENUE621110$325,262$325,262
FieldValueIRS element (for citing)
Total Program Service Revenue$23,893,926TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,675TotalRevenueColumnAmt
Exclusion$7,675ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$50,136RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$15,256RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$34,880RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$34,880TotalRevenueColumnAmt
Exclusion$34,880ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$10,948OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$6,703OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$4,245OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,472TotalRevenueColumnAmt
Exclusion$8,472ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescCAFETERIA INCOMEDesc
Business722514BusinessCd
Total Revenue Column$87,045TotalRevenueColumnAmt
Exclusion$87,045ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$87,045OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$24,386,298TotalRevenueColumnAmt
Related Or Exempt Func Income$23,893,926RelatedOrExemptFuncIncomeAmt
Exclusion$138,072ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$4,797TotalAmt
Program Services$4,797ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$11,057TotalAmt
Program Services$11,057ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,895,705TotalAmt
Program Services$1,669,821ProgramServicesAmt
Management And General$225,884ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,202,125TotalAmt
Program Services$7,982,557ProgramServicesAmt
Management And General$1,219,568ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$362,916TotalAmt
Program Services$316,714ProgramServicesAmt
Management And General$46,202ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,668,020TotalAmt
Program Services$1,324,596ProgramServicesAmt
Management And General$343,424ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$709,067TotalAmt
Program Services$623,153ProgramServicesAmt
Management And General$85,914ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$5,523TotalAmt
Program Services$10ProgramServicesAmt
Management And General$5,513ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$127,453TotalAmt
Program Services$328ProgramServicesAmt
Management And General$127,125ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,005,676TotalAmt
Program Services$2,452,949ProgramServicesAmt
Management And General$549,077ManagementAndGeneralAmt
Fundraising$3,650FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$59,496TotalAmt
Program Services$40,954ProgramServicesAmt
Management And General$18,542ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$567,142TotalAmt
Program Services$428,439ProgramServicesAmt
Management And General$138,703ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$26,789TotalAmt
Program Services$18,673ProgramServicesAmt
Management And General$8,116ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$502,771TotalAmt
Program Services$371,272ProgramServicesAmt
Management And General$131,499ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$40,637TotalAmt
Program Services$34,578ProgramServicesAmt
Management And General$6,059ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$180TotalAmt
Management And General$180ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$454,260TotalAmt
Program Services$352,069ProgramServicesAmt
Management And General$102,191ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,838,603TotalAmt
Program Services$1,217,154ProgramServicesAmt
Management And General$621,449ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$160,026TotalAmt
Program Services$90,755ProgramServicesAmt
Management And General$69,271ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE$1,238,786$1,238,786
REPAIRS & MAINTENANCE$706,859$648,994$57,865
DUES & SUBSCRIPTIONS$202,297$146,100$56,197
MEDICAL SUPPLIES$2,807,804$2,807,804

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$213,815TotalAmt
Program Services$53,286ProgramServicesAmt
Management And General$160,529ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$25,811,804TotalAmt
Program Services$21,834,846ProgramServicesAmt
Management And General$3,973,308ManagementAndGeneralAmt
Fundraising$3,650FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$286BOYAmt
EOY$286EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$3,992,590BOYAmt
EOY$3,895,701EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$49,607BOYAmt
EOY$50,522EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,083,209BOYAmt
EOY$3,440,130EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$486,471BOYAmt
EOY$432,611EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$215,682BOYAmt
EOY$221,831EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$30,641,852LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$17,072,819LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$14,617,871BOYAmt
EOY$13,569,033EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$3,300,249BOYAmt
EOY$494,653EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$26,745,965BOYAmt
EOY$22,104,767EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,558,255BOYAmt
EOY$2,149,650EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,145,000BOYAmt
EOY$6,440,000EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$4,588,686BOYAmt
EOY$242,107EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$500,000BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$11,791,941BOYAmt
EOY$8,831,757EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$14,889,433BOYAmt
EOY$12,754,632EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$64,591BOYAmt
EOY$518,378EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,954,024BOYAmt
EOY$13,273,010EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$26,745,965BOYAmt
EOY$22,104,767EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$1,425,506ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$255,508OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

Total Grassroots Lobbying TotalGrassrootsLobbyingGrp

FieldValueIRS element (for citing)
Filing Organizations Total$6,184FilingOrganizationsTotalAmt
FieldValueIRS element (for citing)
Total Direct LobbyingTotalDirectLobbyingGrp

Total Lobbying Expend TotalLobbyingExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$6,184FilingOrganizationsTotalAmt

Other Exempt Purpose Expend OtherExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$25,805,620FilingOrganizationsTotalAmt

Total Exempt Purpose Expend TotalExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$25,811,804FilingOrganizationsTotalAmt

Lobbying Nontaxable Amount LobbyingNontaxableAmountGrp

FieldValueIRS element (for citing)
Filing Organizations Total$1,000,000FilingOrganizationsTotalAmt

Grassroots Nontaxable GrassrootsNontaxableGrp

FieldValueIRS element (for citing)
Filing Organizations Total$250,000FilingOrganizationsTotalAmt
FieldValueIRS element (for citing)
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp

Avg Lobbying Nontaxable Amount AvgLobbyingNontaxableAmountGrp

FieldValueIRS element (for citing)
Current Year Minus3$1,000,000CurrentYearMinus3Amt
Current Year Minus2$1,000,000CurrentYearMinus2Amt
Current Year Minus1$1,000,000CurrentYearMinus1Amt
Current Year$1,000,000CurrentYearAmt
Total$4,000,000TotalAmt
FieldValueIRS element (for citing)
Lobbying Ceiling$6,000,000LobbyingCeilingAmt

Avg Total Lobbying Expend AvgTotalLobbyingExpendGrp

FieldValueIRS element (for citing)
Current Year Minus3$4,401CurrentYearMinus3Amt
Current Year Minus2$4,425CurrentYearMinus2Amt
Current Year Minus1$5,509CurrentYearMinus1Amt
Current Year$6,184CurrentYearAmt
Total$20,519TotalAmt

Avg Grassroots Nontaxable AvgGrassrootsNontaxableGrp

FieldValueIRS element (for citing)
Current Year Minus3$250,000CurrentYearMinus3Amt
Current Year Minus2$250,000CurrentYearMinus2Amt
Current Year Minus1$250,000CurrentYearMinus1Amt
Current Year$250,000CurrentYearAmt
Total$1,000,000TotalAmt
FieldValueIRS element (for citing)
Grassroots Ceiling$1,500,000GrassrootsCeilingAmt

Avg Grassroots Lobbying Expend AvgGrassrootsLobbyingExpendGrp

FieldValueIRS element (for citing)
Current Year Minus3$4,401CurrentYearMinus3Amt
Current Year Minus2$4,425CurrentYearMinus2Amt
Current Year Minus1$5,509CurrentYearMinus1Amt
Current Year$6,184CurrentYearAmt
Total$20,519TotalAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$769,309OtherCostOrOtherBasisAmt
Book Value$769,309BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$17,213,501OtherCostOrOtherBasisAmt
Depreciation$8,153,568DepreciationAmt
Book Value$9,059,933BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,961,417OtherCostOrOtherBasisAmt
Depreciation$8,247,400DepreciationAmt
Book Value$2,714,017BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,697,625OtherCostOrOtherBasisAmt
Depreciation$671,851DepreciationAmt
Book Value$1,025,774BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$13,569,033TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt$23,153,381TotalRevEtcAuditedFinclStmtAmt
Other Revenue$15,256OtherRevenueAmt
Revenue Not Reported$15,256RevenueNotReportedAmt
Revenue Subtotal$23,138,125RevenueSubtotalAmt
Other Revenues Not Included$1,248,173OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$1,248,173RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$24,386,298TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$24,579,802TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$15,256OtherExpensesIncludedAmt
Expenses Not Reported$15,256ExpensesNotReportedAmt
Expenses Subtotal$24,564,546ExpensesSubtotalAmt
Other Expenses Not Included$1,247,258OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$1,247,258ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$25,811,804TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PART X, LINE 2MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
SCHEDULE D, PART XI, LINE 2DRENTAL EXPENSES $ 15,256
SCHEDULE D, PART XI, LINE 4BGAIN(LOSS) ON DISPOSITIONS OF FIXED ASSETS $ 8,472 CHANGE IN ESTATE RECEIVABLE 915 BAD DEBT EXPENSE 1,238,786 ------------ $ 1,248,173
SCHEDULE D, PART XII, LINE 2DRENTAL EXPENSES $ 15,256
SCHEDULE D, PART XII, LINE 4BGAIN(LOSS) ON DISPOSITIONS OF FIXED ASSETS $ 8,472 BAD DEBT EXPENSE 1,238,786 ------------ $ 1,247,258

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent150Yes (X)Percent150Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent250Yes (X)Percent250Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetfalseFinancialAssistanceBudgetInd
Annual Community Bnft ReportfalseAnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$303,187TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$792DirectOffsettingRevenueAmt
Net Community Benefit Expns$302,395NetCommunityBenefitExpnsAmt
Total Expense0.01200TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,727,820TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,143,945DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,583,875NetCommunityBenefitExpnsAmt
Total Expense0.06400TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$68,112TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$29,936DirectOffsettingRevenueAmt
Net Community Benefit Expns$38,177NetCommunityBenefitExpnsAmt
Total Expense0.00200TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,099,119TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,174,673DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,924,447NetCommunityBenefitExpnsAmt
Total Expense0.07800TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$36,320TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,000DirectOffsettingRevenueAmt
Net Community Benefit Expns$19,320NetCommunityBenefitExpnsAmt
Total Expense0.00100TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$37,526TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$37,526NetCommunityBenefitExpnsAmt
Total Expense0.00200TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$400TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$400NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$74,246TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,000DirectOffsettingRevenueAmt
Net Community Benefit Expns$57,246NetCommunityBenefitExpnsAmt
Total Expense0.00310TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,173,365TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,191,673DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,981,693NetCommunityBenefitExpnsAmt
Total Expense0.08110TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$3,847TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,847NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$7,589TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$7,589NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Total Community Benefit Expns$11,436TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$11,436NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$1,238,786BadDebtExpenseAmt
Bad Debt Expense Attributable$60,000BadDebtExpenseAttributableAmt
Reimbursed By Medicare$20,862,967ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$21,053,737CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$190,770MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HIAWATHA HOSPITAL ASSOCIATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 UTAH STREETAddressLine1Txt
CityHIAWATHACityNm
State AbbreviationKSStateAbbreviationCd
ZIP66434ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.hch-ks.orgWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1HIAWATHA HOSPITAL ASSOCIATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLwww.hch-ks.orgOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt13ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLwww.hch-ks.orgStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care150.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care250.FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Other MethodYes (X)OtherMethodInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLXFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLXFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLXFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Medicare RatesYes (X)MedicareRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, SECTION B, LINE 5WE CHOSE INDIVIDUALS WHO WOULD HAVE UNIQUE UNDERSTANDING OF THE DIFFERENT POPULATIONS IN OUR COMMUNITY TO BE ON THE COMMITTEE. THE COMMITTEE HELPED FORMULATE THE SURVEY TO TAKE TO OUR COMMUNITY AND GAVE SIGNIFICANT FEEDBACK AND DIRECTION ABOUT WHAT SPECIFIC POPULATION NEEDS WERE. INCLUDED ON THE COMMITTEE: KARLA HARTER, NURSING DIRECTOR FOR BROWN COUNTY HEALTH DEPARTMENT; DR. PETE ROSA IS NOT ONLY THE DIRECTOR OF THE MED STAFF WHEN WE DID THE SURVEY BUT ALSO SERVED ON THE LOCAL SCHOOL BOARD; SHERI WESSEL, PA IS THE DIRECTOR OF THE WEIGHT LOSS CLINIC AND WOULD ALSO REPRESENT THE NEMAHA COUNTY POPULATION; DR. CROSBY GERNON WAS THE MAYOR OF HIAWATHA; LYNN DIERKING, RN IS THE DIRECTOR OF OUR HOME HEALTH AGENCY; KAREN WILSON WAS THE DIRECTOR OF THE AREA AGENCY ON AGING; LYNNE LADNER WAS CITY ADMINISTRATOR AND MEMBER OF LOCAL ECONOMIC DEVELOPMENT GROUP; KRISTIN BOLTZ, NURSE PRACTIONER AT WHITE CLOUD HEALTH STATION THAT SERVES IOWA SAC & FOX INDIAN TRIBE; MICHELLE SHAMBURG, PA IS A HEALTH CARE PROVIDER FOR THE KICKAPOO INDIAN NATION; WENDY SHOEMAKER EMT WORKED IN THE WEIGHT LOSS CLINIC.
SCHEDULE H, PART V, SECTION B, LINE 11OUR INITIAL PUSH WAS TO MAKE OUR WEIGHT LOSS CLINIC A SIGNIFICANT FACTOR IN REDUCING COMMUNITY OBESITY. HOWEVER, CHANGEOVER IN PERSONNEL HAS SHIFTED OUR FOCUS TO PROVIDING TRANSPORTATION TO POPULATIONS WITH CHALLENGES AT NO COST.
SCHEDULE H, PART V, SECTION B, LINE 13HBECAUSE WE HAVE A GENEROUS FAP, SOME OTHER LOCAL HOSPITALS WERE DIRECTING PATIENTS THAT MAY NOT BE ABLE TO PAY THEIR BILLS TO OUR FACILITY. TO PREVENT PATIENT SHUFFLING, WE DID INCLUDE A CLAUSE STATING THAT TO BE ELIGIBLE FOR OUR FAP, THE APPLICANTS PRIMARY CARE PROVIDER MUST BE PART OF OUR ACTIVE MED STAFF.
SCHEDULE H, PART V, SECTION B, LINE 15ETHE POLICY STATES PLACES THAT THE APPLICATION IS AVAILABLE, WHAT SUPPORT WILL NEED TO BE INCLUDED, AND TO WHOM THE APPLICATION NEEDS TO BE RETURNED TO.
FieldValueIRS element (for citing)
Facility3FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
HIAWATHA COMMUNITY HOSPITAL HOME HEALTH
300 UTAH STREETHIAWATHAKS66434HOME HEALTH AGENCY
HIAWATHA COMM HOSP FAM PRACTICE CLINIC
300 OREGON STREET 2ND FLOORHIAWATHAKS66434RURAL HEALTH CLINIC
HIAWATHA COMM HOSPITAL HIGHLAND CLINIC
415 S MAIN STREETHIAWATHAKS66434RURAL HEALTH CLINIC

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7THE HOSPITAL USES THE COST-TO-CHARGE RATIO. THIS METHOD WAS USED TO CALCULATE THE FIGURES IN THE TABLE AND WAS DETERMINED BY COMPARING PATIENT CARE COST TO PATIENT CARE CHARGES.
SCHEDULE H, PART I, LINE 7, COLUMN FTHE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $1,238,786.
SCHEDULE H, PART II, LINES 1 - 10LITTLE HANDS DAYCARE IS A NOT FOR PROFIT DAYCARE THAT PROVIDES LICENSED, RELIABLE, QUALITY DAYCARE AND EDUCATION TO CHILDREN IN THE COMMUNITY. ONE OF THE ISSUES CITED BY LOCAL EMPLOYERS WHEN RECRUITING WORKERS WAS A LACK OF OPENINGS WITH LOCAL DAYCARE PROVIDERS. LITTLE HANDS WAS STARTED TO ADDRESS THAT NEED. HIAWATHA HOSPITAL'S CONTRIBUTIONS IN TIME AND SUPPLIES HAS HELPED THEM TO BE ABLE TO PROVIDE QUALITY SERVICES WHILE OPERATING ON MINIMAL MARGINS. HIAWATHA COMMUNITY HOSPITAL LEARNED THROUGH OUR COMMUNITY BENEFIT STUDY THAT TRANSPORTATION IS A BARRIER FOR MANY CITIZENS TO OBTAINING HEALTHCARE. SO WE BEGAN OPERATING A FREE MEDICAL TRANSPORT VAN THAT CAN BE USED WITHOUT COST TO GET PEOPLE TO MEDICAL APPOINTMENTS OR BACK FROM STAYS AT HOSPITALS IN LARGER COMMUNITIES.
SCHEDULE H, PART III, SECTION A, LINE 2ALL APPLICABLE INSURANCE CONTRACT DISCOUNTS, SELF-PAY CONTRACT DISCOUNTS, AND CHARITY CARE SLIDING SCALE DISCOUNTS ARE APPLIED PRIOR TO BALANCE BEING ELIGIBLE TO BE WRITTEN OFF AS BAD DEBT. ONCE THE ACCOUNT IS ELIGIBLE, THE ACCOUNT IS FORWARDED TO THE BOARD OF TRUSTEES FOR CONSIDERATION. ONLY AFTER BOARD APPROVAL IS GRANTED IS THE ACCOUNT IS WRITTEN OFF TO BAD DEBT.
SCHEDULE H, PART III, SECTION A, LINE 3BEFORE MAKING ACCOUNTS ELIGIBLE FOR BAD DEBT, WE RUN ALL ACCOUNTS THROUGH A COMPANY TO CHECK TO SEE IF THEY WOULD LIKELY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THOSE WHO COME BACK AS PROBABLE ARE CONTACTED AND ASKED AGAIN TO COMPLETE A FAP APPLICATION. MANY INDIVIDUALS ARE NOT WILLING TO COMPLETE THE APPLICATION. AT THAT POINT THEY ARE GRANTED PRESUMPTIVE FINANCIAL ASSISTANCE STATUS AND THEIR BALANCES ARE WRITTEN OFF TO CHARITY CARE INSTEAD OF BAD DEBT. WHILE WE FEEL THAT WE WORK VERY DILIGENTLY TO PROVIDE FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY, WE CANNOT GUARANTEE A PERFECT SYSTEM. SO THE ABOVE FIGURE IS AN ESTIMATION OF THE BALANCES THAT MAY HAVE NOT BEEN CAUGHT BY OUR SYSTEM.
SCHEDULE H, PART III, SECTION A, LINE 4PAGE 8 OF THE AUDITED FINANCIAL REPORT
SCHEDULE H, PART III, SECTION A, LINE 8MEDICARE WITHHELD 2% FROM OUR SETTLEMENT THAT REPRESENTS THE SEQUESTRATION AMOUNT. THIS YEAR THAT AMOUNT WAS $190,300. THAT 2% TAKES OUR REIMBURSEMENT BACK TO 99% OF COSTS. WE CONSIDER THE FULL SEQUESTRATION AMOUNT COMMUNITY BENEFIT AS THE HOSPITAL IS PROVIDING SERVICES NOT JUST BELOW THE AGREED UPON RATE WITH MEDICARE, BUT A LOSS AS WE ARE BEING REIMBURSED 99% OF OUR COSTS.
SCHEDULE H, PART III, SECTION B, LINE 9BCHARITY CARE APPLICATIONS ARE MADE AVAILABLE TO ALL PATIENTS AT TIME OF REGISTRATION, ON STATEMENTS, AND ON THE WEBSITE. 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT IS MADE ON AN ACCOUNT, IF PAYMENT ISN'T MADE AND A CHARITY CARE APPLICATION ISN'T COMPLETED THE PATIENT'S NAME IS RUN THROUGH A COMPANY TO CHECK FOR PRESUMPTIVE CHARITY CARE. IF THEY QUALIFY, THEY ARE OFFERED AN APPLICATION AGAIN. IF THEY FAIL TO COMPLETE THE APPLICATION, THEY ARE WRITTEN OFF TO CHARITY CARE UNDER OUR PRESUMPTIVE CHARITY CARE PROGRAM. IF THEY DO NOT QUALIFY FOR CHARITY CARE, AND HAVE NOT RESPONDED TO OUR REQUESTS FOR PAYMENTS FOR 120 DAYS, THEN THE ACCOUNT IS PUT ON A LIST FOR APPROVAL BY THE BOARD OF TRUSTEES. ONCE AN ACCOUNT IS GRANTED APPROVAL BY THE BOARD, IT IS SENT TO THE COLLECTION AGENCY. WE GIVE THE COLLECTION AGENCY SEVERAL MONTHS TO COLLECT THE DEBT. IF THEY ARE UNSUCCESSFUL, THE ACCOUNT IS RETURNED TO THE HOSPITAL AND WRITTEN OFF.
SCHEDULE H, PART VI, LINE 2NOT ONLY DID WE SEEK FEEDBACK FROM COMMITTEE MEMBERS REPRESENTING LESSER HEARD VOICES FROM OUR COMMUNITY, BUT WE MADE AN ONLINE SURVEY AVAILABLE, WE PUT HARD COPIES OF THE SURVEY IN MULTIPLE PLACES INCLUDING ALL OF THE TOWNS IN OUR SERVICE AREA. WE COMBINED THAT FEEDBACK WITH STATISTICAL INFORMATION FROM RELIABLE SOURCES TO IDENTIFY PRIORITIES.
SCHEDULE H, PART VI, LINE 3WE POST INFORMATION ABOUT OUR FAPS EXISTENCE IN PROMINENT LOCATIONS. WE MAKE COPIES OF THE FAP AVAILABLE DURING REGISTRATION, IN INPATIENT ROOMS, ONLINE, AND ON OUR BILLING CORRESPONDENCE.
SCHEDULE H, PART VI, LINE 4THE HOSPITAL SERVES A GEOGRAPHIC AREA THAT ENCOMPASSES ATCHISON, BROWN, DONIPHAN, JACKSON AND NEMAHA COUNTIES IN KANSAS, AND RICHARDSON COUNTY IN NEBRASKA. OF THOSE PATIENTS, 85% ARE FROM BROWN AND DONIPHAN COUNTIES. THESE ARE MOSTLY RURAL COMMUNITIES. 88% OF THE POPULATION OF THE BROWN AND DONIPHAN COUNTIES THAT IS 25 YEARS OR OLDER HAS A MINIMUM OF A HIGH SCHOOL DIPLOMA, 16% HAS A BACHELORS DEGREE OR HIGHER. THE AVERAGE MEDIAN HOUSEHOLD INCOME IS $41,300 COMPARED TO THE STATE WIDE MEDIAN HOUSEHOLD INCOME OF $50,594. 16% OF THE POPULATION LIVES IN POVERTY; 19% FOR BROWN COUNTY ALONE. 16% OF THE POPULATION IN BROWN AND DONIPHAN COUNTIES DOES NOT HAVE HEALTH INSURANCE.
SCHEDULE H, PART VI, LINE 5WE SUPPORT A WIDE ARRAY OF PROGRAMS AND PROJECTS IN OUR COMMUNITY. MANY OF OUR KEY EMPLOYEES SERVE ON MULTIPLE BOARDS THAT HAVE A POSITIVE IMPACT ON VARIOUS ASPECTS OF THE COMMUNITY. WE PROVIDE DONATIONS OF BOTH TIME AND MONEY TO VARIOUS SERVICE ORGANIZATIONS.
SCHEDULE H, PART VI, LINE 6N/A
SCHEDULE H, PART VI, LINE 7KANSAS

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeSCHOLARSHIPSGrantTypeTxt
Recipient6RecipientCnt
Cash Grant$11,057CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PART 1, LINE 2FormAndLineReferenceDesc
ExplanationCOMMUNITY SCHOLARSHIP - HCH HAS GIVEN SCHOLARSHIPS TO COMMUNITY MEMBERS PURSUING A DEGREE IN THE MEDICAL FIELD. AFTER THE SCHOLARSHIP IS APPROVED BY HOSPITAL CEO, THE TUITION IS PAID TO THE SCHOOL, THE STUDENT OR THE STUDENT LOAN HOLDER.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (true)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DR STEFFEN SHAMBURG
PHYSICIAN/CHIEF OF STAFF$358,559$0$55,252$0$0$0$13,552$0$19,866$0$447,229$0$30,151$0
JOHN MOORE
CEO$150,281$0$431$0$5,629$0$6,722$0$21,265$0$184,328$0$0$0
DUSTIN WILLIAMS
PHYSICIAN ASSISTANT$144,979$0$9,617$0$0$0$6,207$0$3,180$0$163,983$0$0$0
DR BRYON BIGHAM
PHYSICIAN$254,205$0$10,749$0$3,942$0$11,114$0$22,366$0$302,376$0$0$0
DR PETER ROSA
PHYSICIAN$236,922$0$30,850$0$0$0$10,184$0$21,704$0$299,660$0$4,126$0
DR CROSBY GERNON
RADIOLOGIST$397,454$0$42,118$0$17,500$0$15,923$0$20,081$0$493,076$0$16,000$0
JEAN ABEITA
PHARMACIST$127,860$0$460$0$0$0$5,471$0$19,866$0$153,657$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 4BDR CROSBY GERNON RECEIVED 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS TOTALING $17,500.
SCHEDULE J, PART I, LINE 6ADOCTORS ARE PAID A PERFORMANCE BONUS BASED ON PRODUCTIVITY AND REVENUES AND EXPENSES.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF HIAWATHA KANSASBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN483025665BondIssuerEIN
CUSIP428545CN5CUSIPNum
Bond Issued2014-09-29BondIssuedDt
Issue Price$6,440,000IssuePriceAmt
PurposeSEE PART VIPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$0RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$6,440,000TotalProceedsAmt
In Reserve Fund$300,003InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$0RefundingEscrowAmt
Issuance Costs From Proceeds$115,920IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$0CapitalExpendituresAmt
Other Spent Proceeds$6,324,080OtherSpentProceedsAmt
Unspent$0UnspentAmt
Substantial Completion2011SubstantialCompletionYr
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropYes (true)MgmtContractBondFincdPropInd
Engage Bond Counsel ContractsYes (true)EngageBondCounselContractsInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Private Bus Use By Others0.00000PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00000TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Change In Use Bond Financed Prop0.00000ChangeInUseBondFinancedPropPct
Remedial Action TakenfalseRemedialActionTakenInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebateYes (true)ExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE A, COLUMN FFormAndLineReferenceDesc
ExplanationTHE SERIES 2014 BONDS WERE ISSUED TO REFUND THE SERIES 2007 BONDS (ISSUED 03/29/2007) AND REFUND TWO TAXABLE BANK LOANS.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BAN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990.
FORM 990, PART VI, SECTION B, LINE 12CALL EMPLOYEES AND DECISION MAKERS FOR THE HOSPITAL ARE COVERED UNDER THIS POLICY. CONFLICTS ARE EITHER REVIEWED BY THE CORPORATE COMPLIANCE OFFICER OR THE BOARD PRESIDENT. AT BOARD MEETINGS, THE BOARD CHAIR IS APPRAISED OF ALL CONFLICTS OF INTEREST AND THEN ASKS THE MEMBER TO ABSTAIN FROM DISCUSSING AND VOTING ON TOPICS OF CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15ATHE DIRECTOR OF HUMAN RESOURCES PERIODICALLY PROVIDES THE PRESIDENT OF THE BOARD OF DIRECTORS WITH A COMPENSATION SURVEY COMPILED BY THE KANSAS HOSPITAL ASSOCIATION. THE SURVEY DELINEATES COMPENSATION PACKAGES FOR ADMINISTRATORS AT HOSPITALS THAT ARE SIMILAR TO HIAWATHA. BASED ON THAT SURVEY, THE ADMINISTRATOR'S PERFORMANCE, AND THE PERFORMANCE OF THE HOSPITAL, THE BOARD SETS THE ADMINISTRATOR'S SALARY. THE LAST EVALUATION WAS GIVEN IN 2012.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9CHANGE IN FOUNDATION ASSETS $(255,508)
FORM 990 PART IX LINE 11GDESCRIPTION:ANESTHESIOLOGY SERVICES TOTAL FEES:607200
FORM 990 PART IX LINE 11GDESCRIPTION:PHYSICAL THERAPY SERVICES TOTAL FEES:378194
FORM 990 PART IX LINE 11GDESCRIPTION:EMR SERVICES TOTAL FEES:292009
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:1728273

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1HIAWATHA HOSPITAL ASSOCIATION FOUNDATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 UTAH STREETAddressLine1Txt
CityHIAWATHACityNm
State AbbreviationKSStateAbbreviationCd
ZIP66434ZIPCd
FieldValueIRS element (for citing)
EIN481223766EIN
Primary ActivitiesFUNDRAISINGPrimaryActivitiesTxt
Legal Domicile StateKSLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity Status11DPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1HHABusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CHARITABLE REMAINDER TRUST (1)BusinessNameLine1Txt
FieldValueIRS element (for citing)
Primary ActivitiesTRUSTPrimaryActivitiesTxt
Legal Domicile StateKSLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd